AB0373 DEPRESSION IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN NORTH INDIA.
Authors: V. Pai, S. S, V. S. Rawat
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis(RA) is a chronic inflammatory polyarthritis, with deformities associated with poor functional outcome. Psychiatric comorbidities are common among them, contributing to poor outcome. <h3>Objectives</h3> This study was aimed at determining prevalence of depression in RA and its association with disease severity. <h3>Methods</h3> This is a cross-sectional study carried out in the OPD/IPD of Rheumatology in a tertiary care hospital in India. This study recruited 272 patients classified as RA, fulfilling 2010 ACR/EULAR criteria, with minimum duration of illness of at least 1 year. Patients with prior psychiatric illness were excluded. Informed consent was taken from all participating patients, after institute ethical clearance. RA disease activity was measured using DAS28 ESR, and these patients were screened for depression with PHQ-2 questionnaire.<sup><b>[1]</b></sup> Patients with depression were further assessed with Depression, Anxiety and Stress Scale (DASS) for depression severity.<sup><b>[2]</b></sup> The functional status was assessed with Health Assessment Questionnaire –Disability Index(HAQ-DI). Data were interpreted by descriptive statistics, and correlation assessed using Spearman correlation coefficient. Regression analysis was used to find odds of significant variables associated with depression. <h3>Results</h3> Twenty-three percent of these patients had depression according to PHQ-2 screen. Forty-four (69.8%) of these had depression on further assessment using DASS questionnaire. The median DAS-28 in mild, moderate, severe and extremely severe depression groups were 4.6, 4.9, 6.4 and 5.3, respectively. There was a significant difference between the 5 groups in terms of DAS-28 (X^2 = 42.209, p = &lt;0.001), with the median DAS-28 being highest in severe depression group. It had a strong association with DASS depression score and with significant p value of &lt;0.001. There was a weak positive correlation between DAS-28 and DASS depression score, though this correlation was not statistically significant (rho = 0.18, p = 0.167). With further regression analysis, it was clear that, TJC, SJC, and ESR, were significantly associated with depression. All of these parameters had an odds ratio of &gt;1, indicating that if each of them increased, odds of having depression would significantly increase. <h3>Conclusion</h3> Depression, though very common, is yet an underestimated co-morbidity in RA and contributes to their functional impairment/ morbidity. RA patients with high TJC, SJC, ESR and disease activity were found to have depression of more severity, which favors the inflammatory hypothesis of depression.<sup><b>[3]</b></sup> Depression, is indeed an under-estimated yet significant comorbidity in patients with RA. This is often missed or over looked by rheumatologists/ clinicians. Early identification with subsequent referral to concerned specialty will definitely improve functional outcomes. <h3>References</h3> [1]Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 2010;8(4):348-53. [2]Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG, Tennant A. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry. 2012 Jan 24;12:6. [3]Nerurkar L, Siebert S, McInnes IB, Cavanagh J. Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry. 2019 Feb;6(2):164-173. Box and whisker plot shows mean DAS28 score in different groups according to DASS category. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.